HomeMy WebLinkAboutBLD2000-00676 r 1
PROPANE/PELLET/WOOD STOVE & TANK INSTALLATION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
(360) 379-4450 FAX (360) 379-4451 (800)831-2678
PERMIT #: BLD00-00676 Received Date 10/12/2000
SITE ADDRESS: 171 EMBODY RD Issue Date 10/12/2000
PORT LUDLOW, 98365 Expiration Date 10/12/2001
APPLICANT: JAMES D KELLY PHONE:
PO BOX 911
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 821073002 Section: 7 Township: 28N Range: 01 E
CONTRACTOR: PETTIT OIL CO PHONE: (360)385-1420
PO BOX 1031
PORT TOWNSEND WA 98368
Contractor's License PETTIOCO88CC Expires 05/01/2001
OWNER, JAMES D KELLY PHONE:
if different: PO BOX 911
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION PROPANE TANK& STOVE INSTALLATION
THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 10/12/2001.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: j.). t. . 7 1/Y'k': p .277VT 9 - eX `T LlA/ -," i'
[ FinalApprov . ®X Y 7-0 2--
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
Inspector's Phone Hours 8:00 a.m. - 9:00 a.m.
SPECIAL CONDITIONS MAY APPLY - SEE REVERSE
HOT LINE AVAILABLE 24 HOURS A DAY
BUILDING PERMoT•APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD00-00676 Received Date: 10/12/2000
SITE ADDRESS: 171 EMBODY RD
PORT LUDLOW, 98365
APPLICANT: JAMES D KELLY PHONE:
PO BOX 911
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 821073002 Section: 7 Township: 28 N Range: 01 E
CONTRACTOR: PETTIT OIL CO PHONE: (360)385-1420
PO BOX 1031
PORT TOWNSEND WA 98368
Contractor's License PETTIOCO88CC Expires 05/01/2001
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: PROPANE TANK & STOVE INSTALLATION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION MAIN:
CODE EDITION: ADD'L: HEAT TYPE:
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM: PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Exist: Exist: Wetland Erosion
Prop: Prop: Seismic Streams
Total: Total: Flood Way Flood Plane
F&W Landslide
Routing Date: Shoreline Aquifer
Forest: Commercial Rural
1-'r ximity - Hat Conditions
Type Amount Paid By: Date: Receipt: Approved/Uate
Propane Tanks/Stoves $48.00 MAM 10/12/00 34709
Total: $48.00
1 is\F_BLD_App_Bld.rpt 10/29/99
OCT-07-2000 10:31 JEFF CO PERMIT CENTER 360 379 445.1 P.01
JEFFERSON COUNT`_COMMUNITY DEVELOPMENT_621 SHERIDAN ST PORT TOWNSEND WA 9836E PH: (360) 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE X PROPANE TANK PELLET STOW --_OTHERR l V C ���
SITE ADDRESS: ' I L� P(k.
Slits/ROAD NAME jj
ZIP 'fi r _0
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9 DIGIT PARCEL ID NUMBER Z2,1 --01 —(-\> Z,
Legal Description: d (� l�- W i iv r ZS) r Pl at—
Subdivision
Name Rr�I!YZ/L;, �' t \ Block Lots►
Section 7 Township North, Range 1 'P'� WM
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APPLICANT 1 i`(� A �`� — t3,., l —1 (.'
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MAILING ADDRESS 9 1 i p 111.lx-c-
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PROPERTY OWNER ` w l"ki J i)yt
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MAILING ADDRESS /�;` /� / -.- j rr` ��
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STATE LICENSE#
EXP.DATE
FEDERAL I.D. #
ay Signing the application form,the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material
falsehood or any omission of a materiel fact made by the applicant/owner with respect to this application vacket may result in this permit being null and void.
I further agree to save.indemnify and hold harmless Jefferson County against all liabilities,judgments, court costs, reasonable attorney's feet and expenses which
may in any way accrue against Jefferson Cpynty as a resat of or in consequence of the granting of this permit.
I further agree to provide access and right of entry TO Jefferson County and it's empioyeas, representatives or agents for the purpose of application review and any
required later inspections. Acce and right of entry to the applicant's property or structure shall Pe requested and shall oCCur during regular business hours.
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APPLICANT SIGNATURE t__, k IA'
3, 4 t"IAJ���d DATE /a I // 16 6
FOR OFFICE USE ONLY d r
5E FEE j� EIPT#REC (,f
c7JJ. ;! CASH/CK Sf
TOTAL , '
DATE'.: (C)IIZ;
—
hah0 ME',PLNCNTRIFORMSVNSTALL.DOC 10/99
TOTAL P.01